PT - JOURNAL ARTICLE AU - Aisha Janjua AU - Tracy Roberts AU - Nicola Okeahialam AU - T Justin Clark TI - Cost-effective analysis of teaching pelvic examination skills using Gynaecology Teaching Associates (GTAs) compared with manikin models (The CEAT Study) AID - 10.1136/bmjopen-2017-015823 DP - 2018 Jun 01 TA - BMJ Open PG - e015823 VI - 8 IP - 6 4099 - http://bmjopen.bmj.com/content/8/6/e015823.short 4100 - http://bmjopen.bmj.com/content/8/6/e015823.full SO - BMJ Open2018 Jun 01; 8 AB - Objective To determine the cost-effectiveness of Gynaecology Teaching Associate (GTA) teaching versus conventional pelvic model (manikin) teaching of pelvic examination skills for final year medical students within a UK undergraduate obstetrics and gynaecology (O&G) curriculum.Methods An economic evaluation was carried out alongside a randomised controlled trial involving 492 final year medical students. 240 students received manikin teaching, and 241 GTA-led teaching. 418 (85%) students completed their assessment. Proficiency in gynaecological pelvic examination on GTAs was estimated by a senior clinical examiner, blinded to the method of teaching, using a standardised assessment tool. University of Birmingham Medical School thresholds were applied to determine proficiency levels; competence (pass) 50%, merit 60% and distinction 70%. Costs incurred in the delivery of both the educational pathways (control and intervention) were combined. All costs are reported in 2013–2014 prices and earlier costs adjusted using inflation indices.Outcome measures Cost per student competent in pelvic examination at completion of a 5-week clinical O&G placement.Results GTA teaching was more effective compared with conventional teaching with 12 more students considered competent at pass level and 28 more students competent at merit and distinction levels, respectively. However, the average cost of GTA teaching was £45.06 per student compared with £7.40 per student for conventional teaching, with an increased cost of £37.66 per student. The incremental cost-effectiveness ratio demonstrated that it cost an additional £640.20 per competent student and £274.37 per student competent at merit level and £274.37 at distinction level compared with conventional manikin-based teaching.Conclusions GTA teaching of female pelvic examination at the start of undergraduate medical student O&G clinical placements is shown to cost more and be more effective. GTA teaching is likely to be considered cost-effective in the context of other tests, and over the lifespan of a competent doctor’s career.Trial registration number NCT01944592.